Evaluation of renal function after laparoscopic partial nephrectomy with renal scintigraphy using 99mtechnetium-mercaptoacetyltriglycine

AIM: We evaluated the functions of an affected kidney after laparoscopic partial nephrectomy (LPN) using renal scintigraphy with (99m)technetium-mercaptoacetyltriglycine ((99m)Tc-MAG3). METHODS: Split renal function of 10 patients who underwent LPN for renal tumors was assessed using renal scintigraphy with (99m)Tc-MAG3 before surgery, and 1 week and 3 months post-surgery. RESULTS: Median operating time was 196.5 min, median tumor diameter was 2.3 cm, mean blood loss was 64 mL and mean ischemic time was 38.5 min. Median change in serum creatinine level pre- to post-surgery was 0.15 mg/dL. Median contribution of the affected kidney to total renal function (calculated using (99m)Tc-MAG3) was 50.0%, 41.7% and 36.1% before surgery, 1 week and 3 months after LPN, respectively. In one patient, the tumor was resected after cooling of the affected kidney with ice slush for 15 min, and the split renal function ratio remained as high as 50% at 3 months post-operatively despite a total ischemic time of 61 min. CONCLUSIONS: This paper evaluated renal function on the affected side before and after surgery by measuring split renal function with renal scintigraphy using (99m)Tc-MAG3. Risk factors for renal dysfunction in the affected kidney after LPN include age over 70 years with more than 30 min warm ischemic time, re-clamping of the renal artery procedure, and a warm ischemic time greater than 60 min. We believe that renal cooling with slush ice prevents renal dysfunction of the affected kidney after LPN with longer warm ischemic times. However, an easier renal cooling technique should be sought for regular use of cooling procedures in LPN.     

Prediction of residual total renal function before nephron-sparing surgery using99mTc-DMSA renal scintigraphy

Background Although radical nephrectomy is the standard treatment for renal cell carcinoma, nephron-sparing surgery is the preferred treatment in patients with a single functioning kidney. It is important before surgery to evaluate the level of residual renal function likely after the operation. In this study, we investigated the prediction of residual renal function, using technetium Tc 99m dimercaptosuccinic acid (^99mTc-DMSA) renal scintigraphy, before nephron-sparing surgery for renal tumors. Methods Preoperative and postoperative evaluation of renal function was done in 11 patients with renal cell carcinoma or renal angiomyolipoma, using^99mTc-DMSA scintigraphy. Nine patients had renal cell carcinoma and 2 had renal angiomyolipoma. Partial nephrectomy was performed in 4 patients and surgical enucleation in 7 patients. Both the predicted total DMSA renal uptake rate prior to surgery and the actual postoperative total^99mTc-DMSA renal uptake rate were obtained. Endogenous creatinine clearance and serum creatinine levels were also obtained. Results There was a good relationship between the predicted and postoperative total^99mTc-DMSA renal uptake rates. The ratio of the postoperative total DMSA renal uptake rate to the predicted total^99mTc-DMSA renal uptake rate was 85% after partial nephrectomy, and 101% after surgical enucleation. There was also a significant correlation between the postoperative total^99mTc-DMSA renal uptake rate and creatinine clearance, and postoperative total^99mTc-DMSA renal uptake rate levels above 11.4% coincided with serum creatinine levels below 2.0 mg/dL. Conclusion Preoperative assessment with^99mTc-DMSA renal scintigraphy is clinically useful for predicting residual renal function after nephron-sparing surgery.     

Open partial nephrectomy for renal tumours: current status

Androgen is a major growth factor in the normal prostate and determines the overall number of prostate cells. Metastatic prostate cancer, while initially responsive to androgen ablation, eventually becomes hormone-refractory and resistant to many treatments. Unfortunately, there are very few agents in the preclinical stage with a seemingly promising future for hormone-refractory prostate cancer (HRPC) that are actually taken through the complete drug development process, including US Food and Drug Administration approval. Many novel strategies under investigation for treating HRPC target metastatic prostate cancer cells that are neither androgen-dependent nor in the proliferative state. Examples of therapies that target this so-called "Achilles' heel" of HRPC include immune therapy, gene therapy, angiogenesis inhibition, and activation of programmed cell death. Unique properties of HRPC allow for the development of novel treatments that target prostate-specific antigen (PSA), human glandular kallikrein-2, or prostate-specific membrane antigen. An inactive prodrug with a thapsigargin analogue, a sesquiterpene lactone from the plant Thapsia garganica, is currently under investigation specifically for the targeted therapy of HRPC. Preclinical data suggest the PSA-targeting abilities of this novel therapy are associated with a nearly complete cessation of tumour growth with minimal toxicity.     

Evaluation of serum cystatin C levels and 99mTechnetium-mercaptoacetyltriglycine-3 renal scintigraphy for the early detection of cisplatin-induced renal toxicity in cancer patients

SUMMARY: Cisplatin has a broad-spectrum antineoplastic activity. Nephrotoxicity is a prominent component of the toxicity profile of cisplatin-based chemotherapy. In recent years, several reports have confirmed that cystatin C (cys-C) demonstrates a better correlation with the glomerular filtration rate than with serum creatinine. Scintigraphic techniques are also widely used in evaluating renal function. In the present study, serum cys-C, serum creatinine concentrations and ^99mTechnetium-mercaptoacetyltriglycine-3 (^99mTc-MAG-3) scintigraphy were studied in 22 cisplatin-naive cancer patients, 3 days before and 24 h after the first cycle of cisplatin-based chemotherapy. Serum cystatin C and creatinine levels increased in cancer patients after chemotherapy (creatinine: from 68 ± 12 to 72 ± 17 nmol/L; cystatin-C: from 0.064 ± 0.025 to 0.072 ± 0.033 jimol/L), but these differences were not statistically significant (P>0.05). Semiquantitative variables of ^99mTc-MAG-S scintigraphy significantly elevated after chemotherapy (T½*: from 10.27 ± 5.00to 16.17 ± 9.40 min, R20/max*: from 0.40 ± 0.12 to 0.67+0.45, Tmax**: from 5.40 ± 4.01 to 7.59 ± 5.30 min; * P <0.001, ** P <0.01, respectively). These results suggest that MAG-3 scintigraphy is a highly sensitive method in the early detection of cisplatin-induced nephrotoxicity. Serum cystatin C doesn't seem to play a role in the early detection of cisplatin-induced nephrotoxicity. As a result, MAG-3 scintigraphy may be used in selected patients who have a predisposition for renal toxicity.     

Postoperative renal function after partial nephrectomy for renal cell carcinoma in patients with pre‐existing chronic kidney disease: A comparison with radical nephrectomy

We assessed whether adequately functioning parenchyma is preserved in patients with pre‐existing chronic kidney disease (CKD) after partial nephrectomy (PN) compared with those who underwent radical nephrectomy (RN). A total of 95 patients with pre‐existing CKD who underwent curative surgery for pathological T1a‐T2N0M0 renal cell carcinoma with a follow‐up period of 12 months or more were the subject of the present study. Of these, 51 patients underwent RN, and 44 PN. Renal function was assessed by using the estimated glomerular filtration rate (e‐GFR). We classified the subjects into two groups according to the preoperative e‐GFR: preoperative e‐GFR 45–59 mL/min/1.73 m² (68 patients); and 30–44 mL/min/1.73 m² (27 patients). In the former group, the probability of freedom from new onset of e‐GFR <45 mL/min/1.73 m² stemmed from the significant difference between the PN and RN groups (P = 0.006; PN: 2 years 64%; RN: 2 years 22%). In contrast, in the latter group, the probability of freedom from new onset of e‐GFR <30 mL/min/1.73 m² was not associated with a significant difference between PN and RN group (P = 0.80). Overall survival and the number of the patients who went on to develop end‐stage renal disease requiring renal replacement therapy between PN and RN were not significantly different in each group. Death from renal cell carcinoma was not noted in either group. PN could significantly prevent development to late‐stage CKD in patients with preoperative e‐GFR 45–59 mL/min/1.73 m² compared with RN. Patients with preoperative e‐GFR 30–44 mL/min/1.73 m² should be reviewed in a more strict study.     

肾部分切除术后术肾功能影响因素37例分析

目的探讨肾部分切除术后术肾功能的主要影响因素。方法回顾性分析2007年10月~2009年7月37例肾癌患者行开放肾部分切除术的临床资料。其中3例为双侧肾癌患者。采用99 mTc-DTPA肾核素扫描评估术前及术后3月术侧肾的肾小球滤过率（GFR）。术中所有患者行单独肾动脉阻断。统计学分析应用t检验和多变量回归分析。结果手术时间80~195min,平均（122.51±25.86）min。肾动脉阻断时间（24.51±8.05）min。肿瘤大小（3.62±0.76）cm。术前及术后3月术肾GFR分别是（47.19±6.85）、（30.40±8.87）mL/min。术侧肾术后GFR下降（16.79±6.35）mL/min,与术前相比下降约34%。经随访3~21月,无复发及转移病例。患者全部无瘤生存。多元回归分析显示,年龄（P=0.004）、术前术肾GFR（P=0.000）及肾动脉阻断时间（P=0.000）对术肾功能的影响有统计学意义。结论年龄、术前术肾肾小球滤过率及肾动脉阻断时间是影响术后肾功能的主要因素。     

Assessment of liver graft function and regeneration by galactosyl-human serum albumin (99mTc-GSA) liver scintigraphy in adult living-donor liver transplantation

Abstract: Background: In adult living‐donor liver transplantation (LDLT), the assessment of the graft functional reserve is very important. We evaluated the graft functional reserve by technetium‐99m‐diethylenetriaminepenta‐acetic acid‐galactosyl‐human serum albumin (^99mTc‐GSA) liver scintigraphy. Patients and method: From May 2003 to September 2006, ^99mTc‐GSA studies were performed in 27 adult recipients on two, four wk after LDLT, the receptor index [ratio of liver to heart‐plus‐liver radioactivity at 15 minutes (LHL15)] (LHL15) was calculated. Recipients were divided into two groups according to LHL15 on two wk after LDLT (group H; >0.935, group L; <0.935). Liver functional tests and recipients’ background parameters were evaluated between the two groups. Result: Group L accompanied higher preoperative model for end‐stage liver disease (MELD) score (p = 0.038), lower graft‐recipient weight ratio (GRWR) (p = 0.032) and older donor age (p = 0.003) compared with group H. There was no significant difference in the graft regeneration rate between two groups. The three‐yr cumulative survival rate was 76.1% in group L and 88.9% in group H. Conclusion: In LDLT, LHL15 has the potential to assess the graft function and predict the recipients’ outcome. Graft function after LDLT may be related closely to the pretransplant MELD score, GRWR, and donor age.     

Laparoscopic partial nephrectomy: evaluation of long-term oncological outcome

PURPOSE: Laparoscopic partial nephrectomy (LPN) has emerged as a viable alternative to open surgery for renal tumors less than 4 cm. We present oncological followup of patients treated with laparoscopic nephron sparing surgery at our institution. MATERIALS AND METHODS: Between September 1996 and December 2001, 48 patients who underwent LPN for clinically localized tumors were found to have pathologically proven renal cell carcinoma. Medical and operative records were reviewed for clinical characteristics, pathological findings and followup information. RESULTS: Mean patient age was 59.7 years (range 32 to 81) and mean followup was 37.7 months (range 22 to 84). Mean tumor size was 2.4 cm (range 1.0 to 4.0). Final pathological stage was pT1 in 42 patients (87.5%) and pT3a in 6 (12.5%). Histology revealed clear cell in 32 patients (66.7%), papillary in 10 (20.8%), chromophobe in 3 (6.3%), collecting duct in 1 (2.1%) and unclassified in 2 (4.2%). Intraoperative frozen section biopsies revealed negative margins in all cases. Final surgical margins were positive in 1 patient (2.1%). Followup evaluation consisting of physical examination and yearly cross-sectional imaging, which revealed no recurrences in 46 of 48 patients (95.8%). One patient with von Hippel-Lindau disease was found to have local recurrence 18 months after LPN and observation was elected. The second patient had recurrence in the same kidney away from the original tumor site approximately 4 years later. CONCLUSIONS: LPN is an effective treatment modality for clinically localized renal cell carcinoma. Oncological outcomes at a mean followup of 3 years are promising, although the durability of oncological outcomes must be determined.     

后腹腔镜肾部分切除术治疗局限性肾肿瘤的临床价值

目的:对比分析后腹腔镜肾部分切除术(RLPN)与开放肾部分切除术(OPN)治疗局限肾肿瘤的临床疗效。方法:43例肾肿瘤患者随机分为两组:其中19例行RLPN,24例行OPN。观察手术时间、术中肾热缺血时间、术中出血量、术后引流量、术后胃肠功能恢复时间、术后住院时间。结果:RLPN组患者的手术时间及术中肾缺血时间均明显较OPN组长,而术中出血量则明显少于OPN组,且胃肠恢复时间及住院时间均明显较OPN组少,差异有统计学意义(P0.05)。结论:后腹腔镜下肾部分切除术治疗局限肾肿瘤疗效确切,出血量及并发症少,微创优势明显,是替代开放手术治疗局限肾肿瘤的有效方法。